Impact of overweight and obesity on radiation dose and outcome in patients undergoing pulmonary vein isolation by cryoballoon and pulsed field ablation

Background: Pulmonary vein isolation (PVI) using pulsed field ablation (PFA) or cryoballoon ablation (CBA) are commonly used single-shot techniques for the treatment of patients with atrial fibrillation (AF). The number of overweight (BMI 25-30 kg/m(2)) and obese (BMI>30 kg/m(2)) patients undergoing PVI is increasing, but data on this patient population is limited. Methods: Consecutive AF patients with a BMI >= 25 kg/m(2) undergoing PFA- or CBA-PVI were included in this retrospective analysis. Baseline characteristics, procedural parameters and 1-year AF-freedom were retrospectively analyzed and compared for both ablation modalities. Results: Of 115 patients (66 % men, 64 years [IQR: 58-71 years], 57 % overweight and 43 % obese) PFA- was performed in 68 % and CBA-PVI in 32 %. Contrast-dye volume (PFA: 80 ml [IQR: 60 - 117 ml] vs. CBA: 130 ml [IQR: 95 - 200 ml], P=0.001) and radiation exposure (PFA: 2196 cGy<middle dot>cm(2) [IQR: 1398 - 2973 cGy<middle dot>cm(2)] vs. CBA: 3239 cGy<middle dot>cm(2) [IQR: 1288 - 5062 cGy<middle dot>cm(2)], P=0.009) was lower in patients undergoing PFA-PVI. Logistic regression analysis identified obesity (OR: 5.58, 95 % CI: 1.63-19.06; P=0.006) and CBA-PVI (OR: 12.93, 95 % CI: 3.51-47.68; P<bold><</bold>0.001) to be associated with increased radiation exposure. Both techniques were comparably safe (PFA: 4 % vs. CBA: 0 %; P=0.3). The median follow-up time was 145 days [IQR: 103 - 294 days]. AF-freedom after 1-year was similar in overweight (82 %) and obese patients (67 %) (HR: 0.61; 95 % CI: 0.29-1.28; P=0.19) as well as in PFA- and CBA-PVI patients (76 % vs. 76 %, HR: 1.37; 95 % CI: 0.63-2.99; P=0.42). Conclusion: Overweight and obese patients undergoing PFA-PVI had lower contrast-dye volume compared to CBA-PVI. Obesity was associated with increased radiation exposure. Both techniques were comparably safe. The 1-year AF-freedom was similar in overweight and obese patients.